A Multi-Institutional Retrospective Analysis on Impact of Timing of RVAD on 1-Year Mortality

Purpose Early insertion of an RVAD may help to mitigate post-LVAD implantation morbidity and mortality. We hypothesize that concomitant RVAD insertion at time of LVAD implantation improves 1-year mortality in comparison to post-operative insertion. Methods A multi-center retrospective study of 826 consecutive patients who received either a HeartMate2 or HVAD between 1/2007 an 12/2017. We identified 91 patients who either had an unplanned or planned early RVAD on index admission. A Cox proportional hazard model was constructed to identify predictors of 1-year mortality. Results There were 91 patients (11%) who required an RVAD after LVAD implantation with 51 (56%) receiving a concomitant RVAD and 40 (43%) post-operatively (Table 1). Concomitant RVAD with LVAD insertion was associated with lower mortality (HR 0.45 [0.27, 0.76], p-value = 0.002, Figure 1). Our multivariable model (which included age, BMI, and ACE-i use) found receiving transplant (HR 0.04 [0.01, 0.29], p = 0.001) and concomitant RVAD (HR 0.51 [0.29, 0.90], p = 0.004) to be independent predictors of 1-year mortality with a final model C-statistic of 0.77. Stratifying concomitant RVAD by intended approach, planned versus unplanned RVAD insertion had a similar survival rate as unplanned approach at 1 year (42.8% versus 28.6%, p-value = 0.08). Conclusion We show in a continuous-flow and multi-institutional cohort that concomitant RVAD insertion at time of LVAD is associated with improved survival at 1 year compared to post-operative insertion.